Welcome to SocialPrescriberPlus™ · Motivational Interviewing - The Stages of Change. Motivational Interviewing Where does Motivational Interviewing fit in the continuum of Communication

Welcome to SocialPrescriberPlus™Social Prescribing for the Health & Wellbeing

Community Referral Pilot

Module 2

Case Management Skills

& Techniques

Module 2

What’s Coming Up?

• Techniques and Skills:– Motivational Interviewing

• Active Listening

– Developing a Care Plan:

• Groups 4 Health

• Mind, Body, Spirit template

• Evaluation:

– For whom?

– Methods

– National Guidance

Motivational Interviewing


What is it?Motivational Interviewing is a structured conversation between you and the patient to strengthen the patient’s own motivation and commitment to change.

Why would I use it? – In General Practice, around 20% of all patients have an underlying

social or well-being issue, for which there is no medical treatment available.

The Social Determinants of Health


What is it?Motivational Interviewing is a structured conversation between you and the patient to strengthen the patient’s own motivation and commitment to change.

Why would I use it? – In General Practice, around 20% of all patients have an underlying

social or well-being issue, for which there is no medical treatment available.

– These issues can reduce the effectiveness of any medical interventions by the GP

– GPs do not have the time or the skills to address these social issues in a 10 minute consultation

– Many patients will not have considered addressing their underlying social issues and will need your help to explore, understand and build their own motivation to change their behaviour.

Motivational Interviewing - The Stages of Change


Where does Motivational Interviewing fit in the continuum of Communication Styles?

Where users are guided effectively, they invariably feel:

Engaged (interested, cooperative, liking the counsellor, ready to keep talking)

Empowered(able to change, hopeful, optimistic)

Open(accepted, comfortable, safe, respected)

Understood(connected, heard, listened to)

Directing Guiding Following

Motivational Interviewing – Concepts

Empathy

The capacity to understand or feel what another person is experiencing from their perspective - the capacity to put yourself in your patient’s position.

Motivational Interviewing - Concepts

The ‘Righting Reflex’

The desire to fix what seems wrong with people and to set them promptly on a better course – relying in particular on

directing.

Ambivalence

Ambivalence is a normal part of preparing for change

Simultaneously wanting and not wanting something, or wanting both of two incompatible things.

Yes! and But!

“Yes!” = Change Talk

The person’s own statements that suggest they are open to considering change

Change Talk

Listen carefully for change talk:

l might, I should, I wish, I want, I can, I will…The reasons are……

It would solve a problem…..I’ve thought about….

My wife/husband mentioned……I read about…

“I think my drinking is getting a bit out of hand……”(Change Talk)

“I mean, l know l need to lose weight for my health……”(Change Talk)

“I love the fresh air and know l will feel better if l get out of the house….”(Change Talk)

Motivational Interviewing - Concepts

The ‘Righting Reflex’

The desire to fix what seems wrong with people and to set them promptly on a better course – relying in particular on directing.

Ambivalence

Ambivalence is a normal part of preparing for change

Simultaneously wanting and not wanting something, or wanting both of two incompatible things.

Yes! and But!

“Yes!” = Change Talk

The person’s own statements that suggest they are open to considering change

“But…” = Sustain TalkThe person’s own arguments for not changing

and for maintaining the status quo

Change Talk and Sustain Talk

“I think my drinking is getting a bit out of hand……”(Change Talk)

“…..but I’ve tried cutting down and it never lasts”.(Sustain Talk)

“I mean, l know l need to lose weight for my health……”(Change Talk)

But l just love burgers and kebabs and chips.”(Sustain Talk)

“I love the fresh air and know l will feel better if l get out of the house….”(Change Talk)

“But I’ve got no friends and nothing to go out for.”(Sustain Talk)

The 4 Stages of Motivational Interviewing

Adapted from: Wagner and Ingersoll

Engage…in the interaction and build trust with client i.e. “I trust and I’m willing to work with this Link Worker”.

Focus…on a specific direction for the conversation i.e. “Let’s discuss your use of drugs”.

Evoke…the patient’s own motivation and commitment for change i.e. “This is what change looks like for me.”

Plan…how and when to change the behaviour i.e. “I am going to make this change in these ways.”

The Stages of Motivational Interviewing

Active Listening

Active Listening – Minimal Intervention

• Use nonverbal cues which show understanding:– Nodding occasionally

– Keep eye contact (where culturally appropriate) – bridge of nose

– Smile

– Body language/leaning forward/open and inviting posture

• Short Words of Encouragement: The person may need help to go on with their story – use words like “I see, Sure, I know, Uh-huh!, Really?, Tell me more or Go on”.

• Actively focus on listening to, and understanding the other person

• Don’t plan your response until they have finished talking

• It is okay to take brief notes but avoid writing while patient is talking to you

Active Listening Exercise

• Working in pairs, take it in turns to recount a work or social situation that particularly frustrated you in the past few weeks.

• Your partner will actively listen to your story and using nothing more than 2 -3 syllables long, will encourage you to expand and go into more detail in order to understand your situation.

• Once finished, the storyteller feeds back to the listener on how they felt the listener responded and encouraged them to share their story.

• Then swap over and repeat the exercise with the listener becoming the storyteller and vice versa.

• 5 minutes for story, 2-3 minutes for feedback

The Techniques of Motivational Interviewing

• Open Questions: How? What? Where? Who? Why? Open questions require more than a single word answer and encourage the client to open up

• Affirmations: positive statements and gestures that recognize client strengths and acknowledge the effort or achievement they have made

• Reflecting: Repeating back or paraphrasing a word or phrase encourages the individual to carry on and expand.

• Summarising: A summary helps to show the individual that you have listened and understood their circumstances and their feelings.

O

A

R

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Motivational Interviewing Techniques – Open Questions

Closed vs Open Questions:

“Did you have a good relationship with your parents?”vs

What can you tell me about your relationship with your parents?

Examples of Open Questions:• How can I help you with ___?• Help me understand ___?• Could you share with me…?• How would it make you feel if……..?• How would you like things to be different?• What are the good things about ___ and what are the less good things about it?• When would you be most likely to___?• What do you think you will lose if you give up ___?• What have you tried before to make a change?• What do you want to do next?• How were you so successful last time?• Tell me more about…• How was that…?• What are you doing that you find helpful?...• When do you notice that?...• Who supports you in your day to day life?...

Motivational Interviewing Techniques - Affirmation

• Affirmations are positive statements and gestures that recognize client strengths and acknowledge the effort or achievement they have made.

• Affirmations build confidence in the client’s ability to change. A positive statement offering emotional support or encouragement.

Examples of affirming responses:• You told me you tried to change before, that shows great determination• I appreciate that you are willing to meet with me today.• It took a lot of courage to come in today• You are clearly a very resourceful person.• You handled yourself really well in that situation.• That’s a good suggestion.• If I were in your shoes, I don’t know if I could have managed nearly so well.• You really care a lot about your family• You were successful in changing in the past• I’ve really enjoyed talking with you today.

Motivational Interviewing Techniques – Reflections

• Using the patient’s language helps them feel heard, builds rapport and ensures that the patient is an active partner in the dialogue. It is also very powerful to have your own thoughts and words reflected back.

• The listener’s voice turns down at the end of a reflective listening statement. This leads to clarification and greater exploration, whereas questions tend to interrupt the patients' flow.

• There are two ways to make a Reflection:

– Repeating: The Listener repeats the client comment/phrase as closely as possible, staying close to what the Speaker has said

– Paraphrasing: The Listener makes a restatement in which the Speaker’s meaning is inferred

Motivational Interviewing Techniques – Summaries

• Summaries can be used throughout a conversation but are particularly helpful at transition points, for example, after the person has spoken about a particular topic, has recounted a personal experience, or when the encounter is nearing an end.

• Summarising helps to ensure that there is clear communication between the speaker and listener. Also, it can provide a stepping stone towards change.

Structure of Summaries – 4 Steps

Step 1• Begin with a statement indicating you are making a summary. For example:

– “Let me see if I understand so far…”– “Here is what I’ve heard. Tell me if I’ve missed anything.”– “Would now be a good time to sum up where we are?”

Step 2• Give special attention to summarising Change Talk made by the client that points towards a

willingness to change. For example:– “You said that you recognised you have been drinking too much.”– “You explained to me about the negative impact on your family and how you wanted to address that.”– “You said you thought that getting out more would help your depression.”

Step 3• End with an invitation. For example:

– “Did I miss anything?”– “If that’s accurate, what other points are there to consider?”– “Anything you want to add or correct?”

Step 4• Depending on the response of the client to your summary statement, it may lead naturally to

planning for, or taking concrete steps towards the change goal.– “Given what we have just discussed, how do you think we might take that forward?”– “So shall we have a look now at how you might make that change happen?”

Motivational Interviewing - OARS Aide Memoire

Open Question Affirmations Reflections Summaries

Consider using Who?, What?, When?, Where?, Why?, How?

• How can I help you with ___?• Help me understand ___?• Could you share with me___?• How would it make you feel

if____?• How would you like things to

be different?• What are the good things

about ___ and what are the less good things about it?

• When would you be most likely to___?

• What do you think you will lose if you give up ___?

• What have you tried before to make a change?

• What do you want to do next?

• How were you so successful last time?

• Tell me more about…• How was that…?• What are you doing that you

find helpful?...• When do you notice that?...• Who supports you in your day

to day life?...

• You told me you tried to change before, that shows great determination.

• I appreciate that you are willing to meet with me today.

• It took a lot of courage to come in today.

• You are clearly a very resourceful person.

• You handled yourself really well in that situation.

• That’s a good suggestion.

• If I were in your shoes, I don’t know if I could have managed nearly so well.

• You really care a lot about your family.

• You were successful in changing in the past.

• I’ve really enjoyed talking with you today.

There are two ways to make a Reflection:

Repeating: The Listener repeats the client comment/phrase as closely as possible, staying close to what the Speaker has said

Paraphrasing: The Listener makes a restatement in which the Speaker’s meaning is inferredThe listener’s voice turns down at the end of a reflective listening statement. This leads to clarification and greater exploration, whereas questions tend to interrupt the patients' flow.

Step 1Begin with a statement indicating you are making a summary. For example:“Let me see if I understand so far…”“Here is what I’ve heard. Tell me if I’ve missed anything.”“Would now be a good time to sum up where we are?”

Step 2Give special attention to summarising Change Talk made by the client that points towards a willingness to change.

Step 3End with an invitation. For example:“Did I miss anything?”“If that’s accurate, what other points are there to consider?”“Anything you want to add or correct?”

Step 4Depending on the response of the client to your summary statement, it may lead naturally to planning for, or taking concrete steps towards the change goal.“Given what we have just discussed, how do you think we might take that forward?”“So shall we have a look now at how you might make that change happen?

Motivational Interviewing Strategies

Social Prescribers can use 9 strategies for Motivational Interviewing to build trust with patients, engage them in their own care, and help them find motivation to adhere to their

care plans

Motivational Interviewing – Strategy No. 1

Ask a question that will prompt change talk as an answer. For example:

“What are some things you can do to make sure you take you medication regularly?”


Ask about the Positives & Negatives, Pros & Cons, Advantages & Disadvantages of the target behaviour:

Positive/Pro/Advantage:

“Thinking about the benefits, how will regularly taking your medication improve your condition?”

Negative/Con/Disadvantage:

“If we think about your medication for a moment, how does your health suffer when you decide to stop taking your

medication?”


When the patient expresses change talk, use an open questionto ask for more details:

“In what way could that happen?”

“ Could you tell me a little more about that?”

“When was the last time that happened?”

“How does that make you feel?”


Ask about a time before the patient enrolled in the scheme:

“How were things different before you agreed to our sessions?”

“What has changed since we started meeting together?”


Look forward. Ask what may happen if the patient makes the changes according to their care plan:

“If you follow the care plan you have written, how do you think things will change for the better?”

“How do you see your health this time next year if you follow the steps we have agreed?”


Ask about extreme outcomes:

“What are the three best things that might happen if you follow the care plan we have worked on?”


Offer ways to help the patient measure the impact of making a change. For example:

“On a scale from one to 10 (where one is not at all important and a 10 is extremely important), how important is it to you

to improve your health/reduce your drug use/take your medication every day?”

Follow up Questions:

“Why do you think that score has improved since last time?”

“What do you think you can do to get closer to a 10?”

“What would it take to get from 6 to an 8?”


Ask about the patient’s main health goals. For example:

“If you are able to improve your mobility, what would you like to be able to do this summer?”

“What activities would you like to get back to doing if your mobility improves?”


Think like the patient and reframe any barriers into a positive strategy:

“You mentioned that taking your medication every night before bed is a hassle. How would it be if you took it in the morning

instead?”

Motivational Interviewing – 9 Strategies

1. Ask a question that will prompt change talk as an answer.

2. Ask for the Pros & Cons, Positives & Negatives of both changing and staying the same.

3. Ask for more details when change talk theme emerges.

4. Ask about a time before the patient enrolled in the scheme.

5. Ask what may happen if the patient makes the changes according to their care plan.

6. Ask about extreme outcomes.

7. Offer ways to clearly measure the impact of making a change (scale of 1 – 10).

8. Ask about the patient’s main health goals.

9. Reframe any barriers into a positive strategy.

Table Exercise

Using Motivational Interviewing Techniques to Encourage Change Talk

Encouraging Change Talk

• Work as a whole table.

• Pick someone to start. They read out the first client comment to the rest of the table and then uses their imagination to answer questions or respond appropriately in order to keep the conversation flowing. – The person to the left then asks an Open Question about the statement

– The person to their left then makes an Affirmation

– The person to their left makes a Reflection

– The person to their left Summarises the patient’s comments.

• The process then starts again, with the person to the left of the previous summariser reading the next statement.

• Then continue around the table to the left until all statements have been read out.


Moving towards Care Planning

Social Identity Mapping – Groups 4 HealthHelping people to create a visual representation of the Social Groups in their lives

Groups 4 Health

• Social Group belonging, and the sense of Social Identity that it provides, has been shown to be a key source of self-esteem, feelings of control, access to social support, and a sense of purpose and meaning.

• Groups 4 Health:

– Evidence-based psychological intervention to improve social connectedness, and in particular, their group-based social identifications.

– Designed for anyone who is concerned about feeling isolated and disconnected from others in their present life or immediate future.

– Includes people with a clinical diagnosis (e.g. depression, chronic pain) as well as people experiencing normal life transitions (e.g. relocation, retirement, transition to parenthood, grief, etc).

– For those receiving the programme, 83% showed an improvement in loneliness and 71% an improvement in depression.

The Stages of Groups 4 Health

• Stage 1 – Mapping your social world:– Help patients to visualise and illustrate their existing social group networks

and relationships between them– This will be used to identify any areas that can be strengthened and

developed further

• Stage 2 – How to make the most of existing social networks:– Discovering the best ways to make the most of their group ties– Identifying key ways to reconnect with old group ties

• Stage 3 – Building new connections:– Identifying new groups that the user would like to join– Developing the confidence to join new groups

• Stage 4 – Ensuring the user’s group ties are sustainable:– Identify and mitigate any issues encountered in managing social groups:

• Transport to groups• Funding for activities• Family pressures

Groups 4 Health Exercise

Groups 4 Health Exercise

• Work in pairs, where one is the patient and the other the Link Worker – the patient uses their own relationships and social world for the discussion.

• The Link Worker engages the patient in looking at the social groups that are important to them:– Talk about the benefits of groups in social activity

– Encourage the user to visualise the groups in their lives

– Illustrate on a flip chart using PostIt Notes and mark the strength of relationships with lines

– Discuss how to connect with old group ties

– Discuss what new groups the user would like to have in the illustration and how you might jointly make that happen

• Then swap over roles.

Motivational Interviewing – The Next Steps

You will know when it is time to move towards co-producing a Care Plan because:

• It feels right from the conversation you are having with the patient

• You hear the patient use ‘Commitment Talk’ - a commitment to achieve a positive goal:

“I will discuss it with my wife/husband.”

“I will make an effort to take my medication every day, as prescribed.”

“I will come to the group if you come with me.”

“I will try not to have alcohol during the week.”

“I think l could give that a try.”

If you meet resistance from the patient, you know you have moved too early - Step back and go back to MI.

Relapse Prevention

ASK: ‘Thinking about the next few weeks, what might get in the way of you achieving your goals and carrying out your action plan?’

Identify Triggers:

– Holidays

– Injury

– Stress/emotional situations

– Pain

– Small lapses into old habits

– Low motivation

– Bad weather

Taking action

Maintaining

RelapsingThinking

Preparing

How to Move to Action

• People must believe:– They have a plan

– They can enact it

– They can stick with it

• Support people to develop a plan for change:– What’s the change I want to make?

– Reasons for changing are…?

– Steps I’ll take are…?

– People will help me by…?

– I’ll know it’s working if…?

– Things that could get in the way are…?

– Things I’ll do to limit this are…?

Goal Setting

Goal AreaWhat do you want to change?

Your GoalsActions for Me Actions for Other

Looking after myself/Taking exercise/Getting out

Practicalities of life -Money/Housing/Benefits

Transport

My work/Hobbies/Volunteering

Happiness with LifestyleDesired social activity

Overall mental well-beingFeeling good about myself

Supported by Family/Friends/Groups

Thinking positively/Feeling optimistic

Managing symptoms & unhealthy behaviours/Taking medication

CreatingSelf Care Plans

Self Care Plans - Principles

• Co-produced with Patient – a summary of ‘What matters to Me’• Topic areas agreed with client – edit topics as needed• Make it colourful and personal, not ‘official’ - use the patient’s own

words• The client’s to keep at home and to use and refer to• Regular review at each meeting – basis for completing Prism and

discussing, “How has it been for you since we last met?”• The Plan is a work in progress, not a finished item and should include:

– How best to support me – what people need to know about me – Any health conditions that groups and agencies need to know about – My goals – What support I am being connected to, such as community groups and

services – What I can do to support myself to meet my goals – Review – how it’s going and what changes have taken place – Permissions – to share stories, be involved in evaluation and satisfaction

surveys.

I can relax my body and mind by….

I can look after myself by…

People & Groups important to me…

___________________________________’s Self Care PlanMy interests….

I can be a good friend by…

I would like to meet up and spend some time with….

I can meet other people by…

I could volunteer…

Evaluation and Reporting

Evaluation – Who For?

• There are at least five stakeholder groups for whom evaluation of Social Prescribing is important:– The benefits to the Patient/Client

– The commissioners of the service and funders (if different)

– The GP/Practice/Organisation providing the referral

– The service/organisation/Community Group the patient/client is referred to

– The Social Prescribing Scheme itself

Evaluating the Benefits to the Client/Patient/Service User

Evaluating the Benefits to the Patient/Client

• Reviews of existing Social Prescribing schemes highlight the challenges of persuading service users to complete or take part in formal evaluation.

• There are at least 31 recognised tools for reporting the outcomes of Social Prescribing

• Many are points based evaluation schemes, developed from an academic standpoint. Most are too long, too complex or cover a narrow dimension of health and wellbeing.

• Whichever evaluation tool is chosen it will never be perfect for every single patient situation.

Tools Used in Evaluation of Social Prescribing Schemes

• Patient Activation Measure (PAM)• Office for National Statistics Personal well-being (ONS 4)• UCLA 3 –point Loneliness scale• New Economics Foundation (NEF) Five Ways to Wellbeing, (New

Economics Foundation, 2008)• Warwick-Edinburgh Mental Well-being Scale (WEMWBS;21,26

,32)• Hospital Anxiety and Depression Scale (HADS;18)• General Anxiety Disorder-7 (GAD-7;27)• Patient Health Questionnaire-9 (PHQ-9;27)• Clinical Outcomes in Routine Evaluation-Outcome Measure

(CORE-OM;22)• Work and Social Adjustment Scale (WSAS;21 ,22)• General Health Questionnaire (GHQ-12;22) • COOP/WONCA.

Evaluating the Benefits to the Patient/Client

• Reviews of existing Social Prescribing schemes highlight the challenges of persuading service users to complete or take part in formal evaluation.

• There are at least 31 recognised tools for reporting the outcomes of Social Prescribing

• Many are points based evaluation schemes, developed from an academic standpoint. Most are too long, too complex or cover a narrow dimension of health and wellbeing.

• Whichever evaluation tool is chosen it will never be perfect for every single patient situation.

• Therefore, consider treating the need to evaluate the engagement as an opportunity to regularly review progress with the patient, not as an end in itself.

The Pillars for Positive Health

Charting Patient Progress through Community Referral

Evaluating and Reporting the Benefits to the Commissioning Organisation

Evaluating the Benefits to the Commissioning Organisation

• Make a pragmatic assessment of what will deliver continued funding/support for the scheme

• Devise a data collection process that meets the needs of both commissioners and the scheme

• Agree qualitative/quantitative metrics and targets with commissioner that will be used for evaluation

• Devise means of delivering improvement in metrics without affecting scheme performance in other areas

• Use SNOMED codes to deliver hard data on performance• Use SF-36 or PAM to deliver subjective data on success• When reporting, use words such as Increase, Growth, Improve,

Expand, Enhance, Build, Enlarge to demonstrate performance.• Always link Outcomes to Output• Include Stories and Testimonials to support hard data.

The SF-36 Health Survey Questionnaire

Evaluation Measure of Choice

The SF-36 Health Survey Questionnaire

• Currently proposed evaluation measure for the Community Referral pilot

• The SF-36-Item Short Form Health Survey questionnaire (SF-36) is a popular tool for evaluating Health-Related Quality of Life. It is a validated at a population level and is a licensed tool.

• The SF-36 measures eight scales: – physical functioning (PF)

– role physical (RP)

– bodily pain (BP)

– general health (GH)

– vitality (VT)

– social functioning (SF)

– role emotional (RE)

– mental health (MH).

• There are two distinct concepts measured by the SF-36: – a physical dimension, represented by the Physical Component Summary (PCS)

– a mental dimension, represented by the Mental Component Summary (MCS)

• All questions contribute in different proportions to the scoring of both PCS and MCS measures.

• The correct calculation of SF-36 summary measures PCS and MCS requires the use of special algorithms, which are strictly controlled by a private company and for which a licence is required.

The Patient Activation Measure(PAM)

NHS(E) Evaluation Measure of Choice

The Patient Activation Measure

• NHS(E) evaluation measure of choice.

• The PAM® is a validated, licensed tool that measures people’s knowledge, skills and confidence (referred to as ‘patient activation’) in managing their own wellbeing.

• By understanding a patient’s activation level, care can be planned appropriately with the individual, leading to improved wellbeing and fewer episodes of unplanned and emergency care.

• The PAM® is a questionnaire comprising 13 questions and is licensed from Insignia Health LLC. The responses match the respondents to one of four levels of ‘activation’, each of which reveals insight into a range of health-related characteristics, including behaviours and outcomes.

• The scores are recorded on an interactive spreadsheet provided by Insignia and the results are then entered onto the patient record.

• Keeping the original response sheet (or scanned version) is useful as individual answers may be used as prompts in coaching sessions.

The Office for National Statistics(ONS 4)

NHS(E) Evaluation 2nd Choice Measure

Office for National Statistics (ONS 4)

Personal Wellbeing Score

Each PWS item is scored as follows: Disagree=0, Neutral=1, Agree=2 and Strongly Agree=3. A high score is better than a low score.

The PWS calculates a summary score as the sum of the four item scores, giving a 13-point scale from 0 (4×Disagree) to 12 (4×Strongly agree). ONS4 does not provide a summary score.

Scoring:

The service/organisation/Community Group the patient/client is referred to

Evaluating the Benefits to the Referred Service

• Your referral may be welcome in that it adds attendees and may make the service viable – or it may be unwelcome in that it puts additional strain on scarce resources/increases waiting times for users

• Always provide positive feedback to the service on the experiences of your users

• Arrange regular meetings with services to understand pressures

• Look for opportunities for synergies and funding opportunities you can help with.

Evaluating the Benefits to the Practice or Referring Organisation

Benefits to the Practice or Referrer

• Don’t underestimate the importance of providing positive informal and formal feedback to referrer organisations.

• Schedule regular feedback during the year and arrange several face to face reviews with lead GP/PMs.

• Share positive stories and testimonials with staff as well as management

• Using SNOMED codes, write a report for the Practice on their Social Prescribing engagement and outcomes.

Record Keeping – Electronic SNOMED Codes

• NHS(E) has worked with NHS Digital to create National Social Prescribing codes for use in GP IT systems to capture Social Prescribing referrals.

• When working with patients/clients referred by GP Practices, Social prescribers should use the following SNOMED CT6 codes for Social Prescribing:

– 871691000000100 | Social prescribing offered (finding)

– 871711000000103 | Social prescribing declined (situation)

– 871731000000106 | Referral to social prescribing service (procedure).

Professional Resources

• *Future NHS Collaboration Platform – Personalised Care Group – Request membership via [email protected]

• Social Prescribing Network - https://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/social-prescribing-networkand @SocialPrescrib2

• Twitter Social Prescribing Wednesday - @SocialPresHour

• Monday Social Prescribing email meet-up [email protected]

• National Association of Link Workers www.connectlink.org Christiana Melam [email protected]

mailto:[email protected]

https://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/social-prescribing-network


http://www.connectlink.org/


Documents

Welcome to SocialPrescriberPlus™ · Motivational Interviewing - The Stages of Change. Motivational Interviewing Where does Motivational Interviewing fit in the continuum of Communication